Plantar fasciitis (PF) affects approximately two-million people in the US, of both athletic and non-athletic populations. This condition can be debilitating and significantly affect one’s quality of life in a very negative way. There are few high quality studies on this condition and the most successful treatments. Treatments range from chiropractic care, physical therapy, injections and surgeries. Fortunately this condition can typically be resolved with conservative treatment and lifestyle modifications that can prevent going under the knife. Simply put, plantar fasciitis is a strain with subsequent inflammation of the thick tissue (plantar fascia) and muscles on the bottom of the foot causing heel pain. Plantar fasciitis (PF) is characterized by biting heel/mid arch pain when first bearing weight in the morning, or after long periods of rest. The pain typically subsides within 5 minutes of walking or running, then worsens with long term activity or weight bearing. It is also associated with tired, achy feet at the end of the day and foot cramps. PF is seen in both active and inactive people, and is rarely the result of an acute injury. PF can be the result of several different factors: repetitive overuse injuries, poor fitting footwear, overtraining, structural abnormalities of the foot and improper gait mechanics. PF often becomes a chronic and/or recurring problem if not given the appropriate treatment and follow up care.
Some contributing factors to the development of plantar fasciitis:
Structural abnormalities: Plantar fasciitis is very commonly seen with pes planus (pictured left), or flat footed individuals. As you can see, this individual’s medial arch is almost flush with the ground. This can create strain on the plantar fascia. Severe injuries resulting in the need for surgical fusion of the foot can also create strain on the plantar fascia. In these cases of severe structural abnormalities, orthotics are typically indicated. Rehabilitation including foot strengthening exercises, chiropractic manipulation and soft tissue techniques can relieve pain and help to alleviate strain on the tissues and resolve flair ups. We use custom orthotics from Foot Levelers in our office. Using a 3-D scanner, we can have custom orthotics made to support the full structure of your foot.
Poorly fitting footwear: Wearing improper footwear over time can lead to PF. If a shoe doesn’t fit your foot properly, your gait is altered during any weight bearing activity. This has an effect on the entire kinetic chain and can ultimately cause strain on the plantar fascia. The strength and flexibility of your foot will determine your best type of footwear.
Overtraining: Can be a huge contributor to PF. What many athletes, weekend warriors and the like tend to overlook is the importance of recovery in their training regimens. If your tissues don’t have optimal nutrition, rest and repair time they start DEgenerate rather than REgenerate. Especially when it comes to long distance running, or quick sprints, the feet have a lot of demand.
Nerve Impingement: Plantar fasciitis can be a symptom of sciatic nerve impingement. The sciatic nerve is the thickest nerve in your body. It originates from your lumbosacral plexus of nerves typically L4-S1/S2 with some individual anatomical variation. Although this nerve is commonly blamed for all radiating leg pain, it is only responsible for pain along its trajectory down the posterior aspect of the leg and foot. In some impingement cases, the pain can skip the back of the leg altogether and go straight to the foot. Impingement along any portion of the nerve can result in pain, but it doesn’t have to be in the leg. If there is enough impingement along this nerve, any added pressure, say forced dorsiflexion of the foot when standing or walking, can be just the right tension to create exquisite foot pain. Our bodies are always trying to protect our nervous system; reflexively the muscles surrounding the nerve will tighten in an attempt to avoid any further stretch or tension of the nerve. Ultimately, this leads to inflammation of the plantar fascia and the surrounding muscles.
Systemic Inflammation: Though general systemic inflammation is typically not the cause of plantar fasciitis, it will increase your symptoms. For this reason we strongly encourage our patients to eat an anti-inflammatory diet specific to their needs. We also understand no one is perfect or eats perfect all the time, which is why we encourage an 80/20 approach; eat clean 80% of the time and use the other 20% to indulge. Curcuminoids, like those found in turmeric are great to help blot down inflammation in acute cases of plantar fasciitis.
Alternatives to conservative care:
Cortisone or steroid injections are very commonly given for Plantar fasciitis. In some really tough cases this can absolutely be necessary to “put out the fire” that is the inflammatory cascade, to get you out of pain initially. We never recommend looking at this option as a cure. Cortisone is a very powerful anti-inflammatory that alleviates pain without correcting the underlying issue, potentiating further injury and recurrent episodes. Another option is surgical intervention. In some cases, surgery is the best option for a particular case. We prefer to exhaust conservative treatment options before travelling down this avenue. A study on an overweight and obese population (43 total) suffering with plantar fasciitis for an average of 34.8 months, were given decompressive surgery to the nerve to the abductor digiti minimi with partial plantar fascia release and tracked over a 4-year period. It was found that 75.6% of patients were in deed pain-free or had only mild pain post-surgery (pain decreased from an 8.5/10 to a 2.5/10). However patient satisfaction post-surgery was only 48%.